The goal of ureteral obstruction treatment is to remove blockages, if possible, or bypass the blockage, which may help repair damage to the kidneys. Because of the complexity of the urinary system, you may need more than one type of treatment.
A ureteral obstruction that causes severe pain may require an immediate procedure to remove urine from your body and temporarily relieve the problems caused by a blockage. Your doctor (urologist) may recommend:
- A ureteral stent, which involves inserting a hollow tube inside the ureter to keep it open.
- Percutaneous nephrostomy, which involves inserting a tube through your back to drain the kidney directly.
- A catheter, which involves inserting a tube through the urethra to connect the bladder to an external drainage bag. This may be especially important if your bladder also plays a role in poor drainage of your kidneys.
Your doctor can tell you which procedure or combination of procedures is best for you. Drainage procedures may be temporary or permanent treatment options, depending on your condition. For instance, many people with kidney blockages have stents or percutaneous nephrostomies placed while receiving chemotherapy for cancer treatment, to ensure that their kidneys are functioning at their best during treatment.
Endoscopic surgery, a minimally invasive procedure, involves passing a lighted scope through the urethra into the bladder and other parts of the urinary tract. The surgeon makes a cut (incision) into the damaged or blocked part of the ureter to widen the area and then places a hollow tube (stent) in the ureter to keep it open. This procedure may be done to both diagnose and treat a condition.
Other surgical procedures
Surgical procedures to correct ureteral obstruction include:
- Ureterolysis. Ureterolysis (u-ree-tur-OL-ih-sis) is a procedure that exposes the ureter and frees it from abnormal fibrous or scar tissues (adhesions).
- Pyeloplasty. During pyeloplasty (PIE-uh-low-plas-tee), the surgeon reopens or repairs the ureter and inserts a hollow tube (stent) to keep the ureter open. The stent remains in place for up to six weeks and is removed during an office visit.
- Partial nephrectomy. During a partial nephrectomy, the surgeon removes the damaged part of the kidney caused by the ureteral obstruction.
- Ureterectomy. In this procedure, the surgeon removes all or part of a ureter, then reconstructs the urinary tract by lowering the kidney and stretching the bladder up or replacing the ureter using other body tissue.
- Ureteral reimplantation. In this surgery, a poorly functioning section of the ureter is removed and the remaining healthy sections are reconnected and reattached to the bladder.
- Transureteroureterostomy. During transureteroureterostomy (trans-u-ree-tur-oh-u-ree-tur-OS-tuh-me), the surgeon joins one ureter to the other, resulting in sustained improvement in long-term renal function.This procedure isn't recommended if you have stone disease or cancer in the ureters.
These surgical procedures may be performed through any one of these surgical approaches:
- Open surgery, during which your surgeon makes an incision in your abdomen to perform the procedure.
- Laparoscopic surgery, which is performed through a small tube with a light and a camera that allows your surgeon to see inside you. The surgeon makes one or more small incisions through your skin to insert the lighted tube and other instruments needed for the procedure.
- Robot-assisted laparoscopic surgery, during which your surgeon uses a robotic system to perform a laparoscopic procedure.
The main differences among these surgical approaches are your recovery time after surgery and the number and size of incisions used for the procedure. Your doctor (urologist) determines the type of procedure and the best surgical approach to treat your condition.
Ureteral obstructions may be associated with infections that also need to be treated.
Your doctor may prescribe a single-dose of an antibiotic medication when you have a ureteral obstruction treatment procedure performed. A longer course of antibiotics may be needed if infection is a part of the original problem that damaged your kidneys. Antibiotics may also be recommended when a stent or percutaneous nephrostomy tube is removed.
If having a stent in place causes severe abdominal pain, which can sometimes happen, your doctor may prescribe an alpha blocker to manage this side effect.
Feb. 15, 2014
- Zeidel ML, et al. Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis. http://www.uptodate.com/home. Accessed Aug. 20, 2013.
- Taal MW, et al. Brenner & Rector's The Kidney. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.clinicalkey.com. Accessed Aug. 20, 2013.
- DiMarco DS, et al. Long-term success of antegrade endopyelotomy compared with pyeloplasty at a single institution. Journal of Endourology. 2006;20:707.
- Iwaszko MR, et al. Transureteroureterostomy revisited: Long-term surgical outcomes. The Journal of Urology. 2010;183:1055.
- Knoedler J, et al. Population-based comparison of laparoscopic and open pyeloplasty in paediatric pelvi-ureretic junction obstruction. BJU International. 2013;111:1141.
- Lightner DJ (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 3, 2013.
- Castle EP (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. Sept. 23, 2013.
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